HISTORY

I always start by asking people to explain why they are there here—”what is the problem?”. Encourage them to expand their account and discourage them from using “medical” words. Sometimes this needs to be done repeatedly and patients may look askance but I think it is the best way to give them free rein to actually describe the symptoms rather than use the medical words in an attempt to help. They may also use words or labels from prior medical consultations and this should also be discouraged. What is it they cannot do, why can they not do it, what is it that limits them? Once you have a basic account this can be reiterated and confirmed. It also helpful to dictate the letter with the patient listening—it helps to be sure you have heard and understood what they have tried to tell you.

It is critical to date onset of symptoms—“how far back in time do you think this problem could go?”. The age at which symptoms became troublesome is the usual initial response but further enquiry may reveal a much longer story. Questions should be asked (of parents if possible) about birth and the neonatal period. The age at walking should be noted; did they walk or behave differently from their siblings? Parents are good witnesses of differences between children and often suspect a neuromuscular disorder before any professional can find an abnormality. This happens most often where there …